Free Living Amoeba

• Survive and replicate in the environment

without a host (no insect vectors etc)

• Infection of humans is infrequent but life-

threatening

• 3 genera which can cause disease in

humans:

 Naegleria – Primary amebic

Naegleria fowleri

• N. fowleri is the only species of Naegleria

genus that is pathogenic to humans
• Ubiquitous in nature – fresh water, lakes
and ponds (especially warm water)

• Exists in 3 forms:

 Trophozoite - invasive, reproductive form

(7-20υm),Which thrives in temperatures
The Pathogenesis and Life Cycle

Naegleria fowleri has 3 stages in its life cycle: , ameboid

trophozoites , flagellates, and cysts.

The only infective stage of the ameba is the ameboid

trophozoite. Trophozoites are 10-35 µm long with a granular
appearance and a single nucleus.

The trophozoites replicate by binary division. Trophozoites

infect humans or animals by penetrating the nasal tissue and
migrating to the brain via the olfactory nerves causing
primary amebic meningoencephalitis (PAM).
Epidemiology

• N. fowleri has been isolated all over the World

• In 1997, approximately 200 cases have been
reported worldwide with 81 cases the US
(primarily in central and southeast)

• Risk factors: jumping/diving/ swimming

• Males/females =3/1

• Mortality rate > 95%

Pathophysiology

• Trophozoites penetrate the nasal mucosa during

inhalation or aspiration of contaminated water

• The organisms migrate via the olfactory nerves to

invade brain tissue

• Enzymes are produced resulting in rapid

hemorrhage and necrosis of the brain
Clinical Presentation

• Indistinguishable from acute bacterial meningitis

• Symptoms begin 2-14 days from exposure

• Initially may notice change in taste/smell

• Abrupt onset of fever, nausea, vomiting

• Mental status changes seen in 66%

Diagnosis

• Molecular studies – PCR/DNA probes under research

• CT scan of head

• No diagnosis for PAM

• Lumbar Puncture

• Elevated protein level (usually >100)

• High or low glucose

Treatment

• Early diagnosis, drug therapy and supportive care are

necessary in order to increase chances of survival (7
documented survivors)

• Amphotericin B is the mainstay of therapy, successful

outcomes are reported with high-dose

• New studies show that azithromycin may be a useful

addition to therapy (Goswick, 2003)
Prevention

• Avoid swimming or jumping into warm fresh water

bodies

• Chlorination of swimming pools effective

• Presence of serum antibodies in the majority of

young adults tested in southern US indicates
subclinical infection/exposure

• Factors that protect most from invasive Naegleria not

understood